Patient preferences for increasing the role of the pharmacist in the management of drug therapy

Tinelli, Michela and Ryan, Mandy and Bond, C.
(2006)
Patient preferences for increasing the role of the pharmacist in the management of drug therapy.
In: Health Services Research and Pharmacy Practice Conference, April 2006, Bath, UK.
(Unpublished)

Abstract

Introduction An extended role for pharmacists in medicine management, clinical decision-making and patient support is being increasingly recognised. Policy documents encourage appropriate use of pharmacists' skills and expertise in delivering services and have already introduced enhanced programmes of care. Supplementary prescribing by community pharmacists is the most ambitious of recent initiatives . The aim of this study was to investigate patients' preferences for an innovative prescribing role for pharmacists in the management of drug therapies, compared to the more traditional role. The perceived benefits are an increased convenience for the patient and more efficient use of the healthcare workforce. Methods The project was a cross-sectional pilot study based in two city centre multi partnered General Practice in Aberdeen, Scotland. A self-completed questionnaire was administered to a convenience sample of patients aged > 18 years waiting to see their doctor at the surgery. A Discrete Choice Experiment (DCE) was used to elicit patient preferences for extending the role of the pharmacist to include prescribing as well as dispensing. The new service proposed was compared to both the current situation and alternative dispensing pharmacist scenarios. Attributes included were: time spent travelling to, and waiting in, the GP surgery; time spent travelling to, and waiting in, the pharmacy; chance of receiving the "best" treatment; and cost. A multinomial regression analysis was used to estimate factors that influence patients' preferences, their relative importance, trade-offs between attributes and willingness to pay for alternative ways of managing drug treatment. Results 244 people were approached and 204 returned an evaluable questionnaire. All attributes, except time spent travelling to, and waiting in, the pharmacy, were important in choosing the service. A unit change in the 'best' treatment and 'cost' attributes was the most important. The respondents were willing to pay over £10 for a 1% improvement in the 'best' treatment attribute and £1 for a 20-minute reduction in time spent travelling and waiting to see the doctor. Everything else being equal, respondents preferred the current situation to either a pharmacist prescribing and dispensing role, or alternative dispensing only services. However, they could be compensated for changes from the current situation by improvements in the best treatment and GP time attribute. When older individuals providing constant preferences for the whole choice set were dropped, respondents preferred the innovative service to any other dispensing only option and they were prepared to pay £7 to move to the new service. Discussion Overall, patients value input from their pharmacists, but are resistant to change, with evidence of preferences for the current situation. Younger people, who are willing to trade between alternatives, preferred the innovative prescribing and dispensing service. The role of pharmacists in medicine management and clinical decision-making is clearly an important policy concern. UK has already supported a greater NHS role for pharmacist prescribing and supply of both OTC and prescription medicine. Results from the present study show that further changes could be supported by the public. The DCE approach has been shown to be useful in valuing preferences for pharmacy services.